Validation of a classification system for treatment-related mortality in children with cancer

Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of the following: intravenous chemotherapy < 14 days from death; more than one emergency department visit; and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included those same individual measures and measures of the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death). We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer-related mortality, excluding treatment-related mortality (TRM) cases. Results The study included 815 patients; of these, 331 (40.6%) experienced HI-EOL care. Those with hematologic malignancies were at highest risk (odds ratio, 2.5; 95% CI, 1.8 to 3.6; P < .001). Patients with hematologic cancers and those who died after 2004 were more likely to experience the MI-EOL care (eg, intensive care unit, mechanical ventilation, odds ratios from 2.0 to 5.1). Excluding cases of TRM did not substantively change the results. Conclusion Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Of concern, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of population trends in EOL care and identifies high-risk populations for future interventions.

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Induction death and treatment-related mortality in first remission of children with acute lymphoblastic leukemia: a population-based analysis of the Austrian Berlin-Frankfurt-Münster study group

Leukemia ◽

10.1038/leu.2009.12 ◽

2009 ◽

Vol 23 (7) ◽

pp. 1264-1269 ◽

Cited By ~ 45

Author(s):

C Prucker ◽

◽

A Attarbaschi ◽

C Peters ◽

M N Dworzak ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Population Based ◽

Study Group ◽

First Remission ◽

Treatment Related Mortality ◽

Related Mortality

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GVHD Prophylaxis with Post-Transplant High Dose Cyclophosphamide: Impact on Engraftment, Treatment-Related Mortality and Resource Utilization

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2015.11.922 ◽

2016 ◽

Vol 22 (3) ◽

pp. S397-S398

Author(s):

Nasheed Mohammad Hossain ◽

Patricia Lamont Kropf ◽

Stefan Klaus Barta ◽

Mary Ellen Martin ◽

John Ulicny ◽

...

Keyword(s):

Resource Utilization ◽

High Dose ◽

Post Transplant ◽

Gvhd Prophylaxis ◽

Treatment Related Mortality ◽

Related Mortality

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Adenovirus (ADV) Infection In Pediatric Allogeneic Stem Cell Transplantation (AlloSCT) Recipients Is A Major Independent Factor For Significantly Increasing The Risk Of Treatment Related Mortality

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2009.12.313 ◽

2010 ◽

Vol 16 (2) ◽

pp. S258 ◽

Cited By ~ 1

Author(s):

N.K. El-Mallawany ◽

D. George ◽

Z. Jin ◽

P. Della-Latta ◽

P. Satwani ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Independent Factor ◽

Risk Of Treatment ◽

Treatment Related Mortality ◽

Related Mortality

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C-Reactive Protein Levels at Diagnosis of Acute Graft-versus-Host Disease Predict Steroid-Refractory Disease, Treatment-Related Mortality, and Overall Survival after Allogeneic Hematopoietic Stem Cell Transplantation

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2017.10.025 ◽

2018 ◽

Vol 24 (3) ◽

pp. 600-607 ◽

Cited By ~ 4

Author(s):

Lia Minculescu ◽

Brian Thomas Kornblit ◽

Lone Smidstrups Friis ◽

Ida Schiødt ◽

Soeren Lykke Petersen ◽

...

Keyword(s):

Refractory Disease ◽

C Reactive Protein ◽

Disease Treatment ◽

Hematopoietic Stem ◽

Graft Versus Host ◽

Protein Levels ◽

Reactive Protein ◽

Treatment Related Mortality ◽

Related Mortality ◽

Steroid Refractory

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Increased transplant-related morbidity and mortality in CMV-seropositive patients despite highly effective prevention of CMV disease after allogeneic T-cell–depleted stem cell transplantation

Blood ◽

10.1182/blood.v95.7.2240.007k08_2240_2245 ◽

2000 ◽

Vol 95 (7) ◽

pp. 2240-2245 ◽

Cited By ~ 3

Author(s):

Annoek E. C. Broers ◽

Ron van der Holt ◽

Joost W. J. van Esser ◽

Jan-Willem Gratama ◽

Sonja Henzen-Logmans ◽

...

Keyword(s):

Overall Survival ◽

Risk Factor ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Graft Versus Host Disease ◽

Graft Versus Host ◽

Cmv Disease ◽

Treatment Related Mortality ◽

Related Mortality ◽

Acute Graft

We evaluated the efficacy, toxicity, and outcome of preemptive ganciclovir (GCV) therapy in 80 cytomegalovirus (CMV)-seropositive patients allografted between 1991 and 1996 and compared their outcome to 35 seronegative patients allografted during the same period. Both cohorts were comparable with respect to diagnosis and distribution of high- versus standard-risk patients. All patients received a stem cell graft from an HLA-identical sibling donor, and grafts were partially depleted of T cells in 109 patients. Patients were monitored for CMV antigenemia by leukocyte expression of the CMV-pp65 antigen. Fifty-two periods of CMV reactivation occurring in 30 patients were treated preemptively with GCV. A favorable response was observed in 48 of 50 periods, and only 2 patients developed CMV disease: 1 with esophagitis and 1 with pneumonia. Ten of 30 treated patients developed GCV-related neutropenia (less than 0.5 × 109/L), which was associated with a high bilirubin at the start of GCV therapy. Overall survival at 5 years was 64% in the CMV-seronegative cohort and 40% in the CMV-seropositive cohort (P = .01). Increased treatment-related mortality accounted for inferior survival. CMV seropositivity proved an independent risk factor for developing acute graft-versus-host disease, and acute graft-versus-host disease predicted for higher treatment-related mortality and worse overall survival in a time-dependent analysis. We conclude that, although CMV disease can effectively be prevented by preemptive GCV therapy, CMV seropositivity remains a strong adverse risk factor for survival following partial T-cell–depleted allogeneic stem cell transplantation.

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